Provider Demographics
NPI:1710148036
Name:MEAGHER, STEVE DANIEL (LISW)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:DANIEL
Last Name:MEAGHER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6356
Mailing Address - Country:US
Mailing Address - Phone:575-725-5735
Mailing Address - Fax:575-956-9201
Practice Address - Street 1:502 W BONBRIGHT ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5046
Practice Address - Country:US
Practice Address - Phone:575-725-5735
Practice Address - Fax:575-725-5735
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-06212104100000X
NMI-073881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97420841Medicaid